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Ethics Commentary: Treatment of PTSD Empirically Based and Ethical Clinical Decision Making
Shawn P. Cahill, Ph.D.; RaeAnn Anderson, M.S.
FOCUS 2013;11:362-367. doi:10.1176/appi.focus.11.3.362
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Author Information and CME Disclosure

Shawn P. Cahill, Ph.D., University of Wisconsin – Milwaukee, Milwaukee, WI

RaeAnn Anderson, M.S., University of Wisconsin – Milwaukee, Milwaukee, WI

The authors report no competing interests.

Adress correspondence to Shawn P. Cahill, Ph.D., Department of Psychology, University of Wisconsin–Milwaukee, 2441 E. Hartford Ave., Milwaukee, WI 53201; e-mail: cahill@uwm.edu.


A physician has just completed an assessment of a female survivor of a rape that occurred 6 months earlier. She meets full criteria for chronic posttraumatic stress disorder (PTSD) and major depressive disorder of moderate severity. Although she does not meet criteria for alcohol dependence, she has a history of episodic binge drinking that has increased in frequency since the assault. Also since the assault, she has had intermittent bouts of suicidal ideation but denies any intent or specific plan and has no history of past suicide attempts or nonsuicidal self-injury. The patient indicates a clear preference for psychotherapy over medication as a starting point for treatment, but is willing to consider medication if psychotherapy is not a practical option or psychotherapy proves inadequate. The physician does not feel personally qualified to provide psychotherapy for PTSD and the patient asks the physician for a referral, with a plan for a follow-up visit in 3 months to reconsider the medication option. What kind of referral should the physician provide and what ethical issues should be considered in making the referral?

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Table 1.Representative Published Guidelines for Pharmacotherapya
Table Footer Note

a Key to abbreviations: SSRIs=selective serotonin reuptake inhibitors; SNRIs=serotonin–norepinephrine reuptake inhibitors; MAOIs=monoamine oxidase inhibitors; TCAs=tricyclic antidepressants.

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Table 2.Representative Published Guidelines for Psychotherapya
Table Footer Note

a Key to abbreviations: CBT=cognitive behavior therapy; CT=cognitive therapy; SIT=stress inoculation training; CPT=cognitive processing therapy; EMDR=eye movement desensitization and reprocessing.



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